Citizen participation in the conduct of studies, surveys and investigations

📜🔗LINK to the source

1. Analytical summary

Context, tensions and target audiences

Since 2016, Public Health France has committed to a strategy of openness to society, with a steering and dialogue committee (COD) and a shared openness charter with other public institutions. The document starts from the observation of repeated health crises, challenges to expert opinion, and criticisms of studies deemed disconnected from the expectations of the populations (HIV, environment, local investigations, national surveys). It describes the "participatory turn" and the rise of participatory democracy in health, marked by demands for transparency, consideration of experiential knowledge, and empowerment of citizens. Internal barriers (closed expertise culture, fear of controversy, lack of time and resources) and external constraints (judicialisation, media coverage, politicisation, economic issues) are explained. The guide is aimed at SpF agents, but it is directly transferable to ARS, local authorities, associations, and partners involved in studies, surveys, or local investigations.

Methodological contributions and operational tools

The guide proposes a structured framework for participation modalities (information, consultation, dialogue, co-construction) inspired by Arnstein's ladder and adapted to SpF activities. It provides a grid with 13 criteria (trust, quality, feasibility) to decide on the level of stakeholder involvement, as well as a precise sequencing of the participatory process in three phases (preparing, conducting, engaging after the study). Sections detail the identification, qualification, and mapping of stakeholders, the construction of the committee structure (thematic support committee, interface committee, articulation with CSS/CLI), and the adapted communication strategy. The practical sheets (1 to 9) provide concrete tools for organizing public meetings, hearings, consultations, and co-construction processes, as well as the dissemination of information and the presentation of results. Finally, the document emphasizes accountability, the evaluation of participatory processes, and the long-term integration of these practices.

2. Key points of the document

1. The participatory turn and the issues of trust (p. 10–14)

   The preamble describes the rise of participatory democracy in health, the history of participatory approaches at SpF, the expected benefits (trust, empowerment, quality of studies, better reception of results) and the internal/external barriers to these approaches. This framing is essential to understand why and in what contexts participation becomes a methodological requirement.

2. Typology of levels of participation and usage benchmarks (p. 15–19)

   Part 1 clearly distinguishes between information, consultation (surveys, hearings), collaboration, and co-construction, situating them on a continuum inspired by Arnstein and Health Canada. For each level, the guide offers definitions, concrete examples (Lubrizol, Lacq, Gardanne, declared health studies, biosurveillance), and uses adapted to surveillance, prevention, and investigation activities.

3. Multi-criteria decision grid for choosing the level of participation (p. 19–24)

   A grid with 13 criteria (request for participation, risk perception, history, media coverage, economic issues, politicisation, judicialisation, controversy, local issue, expected contribution, vulnerability of populations, timelines, budget) allows for the assessment of the opportunity and intensity of a participatory approach. The guide also proposes a collective arbitration method (project team, management, COD) without fetishising the score, which is used as a discussion support rather than as an automatic threshold.

4. Complete sequencing of a participatory process (p. 25–33, 41–47)

   Figure 3 presents the three phases: prepare (objective, purpose, scope, identification and mapping of stakeholders, choice of mechanism, communication plan), conduct (coordination, rules of the game, facilitation of meetings, traceability, integration of results into the protocol), and engage after the study (sequenced feedback, information for the various committees, evaluation). These steps are detailed with 'in practice' notes and references to annex sheets.

5. Ready-to-use practical sheets (p. 53–73)

   Nine sheets provide step-by-step instructions: conducting a public meeting (sheet 1), choosing the meeting format (sheet 2), interviewing stakeholders (sheet 3), leading a consultation (sheet 4), co-constructing a study (sheet 5), disseminating information to stakeholders (sheet 6), typology of committees (sheet 7), example of a consultation charter (sheet 8), presentation of results to committees (sheet 9). They constitute an immediately deployable toolkit for field teams, including outside SpF.

3. Action points for local actors

1. Formalise an explicit choice of the level of participation for each project (p. 15–24, 33)

   Before any local survey or investigation, use the multi-criteria grid (p. 24) to collectively discuss the level of participation to be implemented, involving at least the project team, a governance representative, and, if possible, a member from a citizen or associative committee. Document this choice in a short internal note or project protocol, clearly indicating what is open for discussion and what is not.

2. Systematise the analysis and mapping of stakeholders in advance (p. 27–33)

   Draw inspiration from the table "characteristics of stakeholders" to locally identify elected officials, associations, collectives, health professionals, residents, economic actors, and social intermediaries, relying on ARS, ORS, and associative networks. This mapping can be carried out quickly through 5–10 targeted interviews, noting motivations, contribution capacities, potential tensions, and links between actors.

3. Integrate a "participation" module into local project methodologies (p. 25–27, 41–44, 57–59)

   For each project (study, programme, local scheme), insert a specific block "participatory scheme" containing: objectives, targeted audiences, schedule of dialogue times, methods (information, consultation, discussion, co-construction) and expected deliverables (opinions, recommendations, questions/answers). The actors can take the steps from sheets 4 and 5 to structure their discussions or co-constructions, particularly in the contexts of polluted sites, clusters or environmental controversies.

4. Secure public meetings and feedback sessions (p. 16–18, 41–46, 53–56, 61, 69–73)

   Rely on sheet 1 (public meeting) and sheet 6 (information dissemination) to prepare meetings with residents: key messages, accessibility (easy-to-read, reference "Communicate for all"), dialogue rules, emotion management, interaction with the media. Systematically plan a feedback session for stakeholders before any national communication, with a question-and-answer time and a clear commitment on how their comments will be addressed.

5. Establish a systematic accountability process after each participatory approach (p. 43–44, 47, 59)

   At the end of a process (consultation, discussion, co-construction), produce a short document explaining what has been retained, what has not been retained and why, based on scientific and operational arguments. Present this feedback to the relevant committees and participants, and use it as a basis to adjust future studies or actions (integration of pathologies, adaptation of questionnaires, new analyses).

4. Additional references 

🔍➕ For more information, see the articles referenced by "Practices in Health" on the theme of participation ➡️🔗 https://www.pratiquesensante.com/participation

1. Practical guide "Towards a participatory public health" – Centre of excellence on partnership with patients and the public (CEPPP), 2025.

   Complementarity: provides a framework and tools to integrate citizen participation at all stages of a public health approach (planning, implementation, evaluation), with a strong focus on partnership with patients.

2. File "Acting for health with citizens" – Review Health in action, Public Health France, 2025.

   Complementarity: illustrates through recent French experiences (programmes, research, community approaches) the concrete implementation of citizen participation in health, echoing the methodological guidelines of the guide.

3. "Users, patients, citizens: towards a more embodied health democracy" – ARS Île-de-France, 2025.

   Complementarity: specifies the role of user representatives, dialogue spaces (CDU, regional bodies) and operational levers to strengthen health democracy at the regional level, in conjunction with the participatory approaches of the agencies.

All URLs have been verified as accessible as of 23/06/2026.

5. Frequently asked questions (FAQ)

1. Who is the main audience for this guide and can it be used outside of Public Health France? (p. 10, 13)

   The guide is primarily intended for SpF agents involved in studies, surveys and investigations, but it is explicitly designed to be shared with their partners (ARS, local authorities, institutions, associations). The concepts, methods and practical sheets are transferable to any actor wishing to structure a participatory approach in a public health or environmental health project.

2. How to choose between information, consultation, dialogue and co‑construction? (p. 15–19, 19–24, 33)

   The choice depends on the intensity of the desired participation, the proximity to the decision, the context of controversy, and the available resources. The multi-criteria grid (p. 24) and the collegial discussion within the project team and management allow for deciding whether a simple information device is sufficient or if a dialogue or co‑construction is necessary.

3. What are the main expected benefits of participatory approaches? (p. 10–13)

   The guide identifies several benefits: improvement of trust between the population and institutions, development of empowerment, better methodological quality of studies (relevance of questions, consideration of experiential knowledge), better understanding and acceptability of results, and improvement of public decision-making.

4. How to identify and select the stakeholders to involve? (p. 27–33, 28–31)

   The document proposes a structured list of categories of actors (public authorities, professionals, civil society, media) and a table to qualify their involvement, expectations, knowledge, and capacity for contribution. It recommends complementing this identification with societal monitoring, targeted interviews, and, if necessary, a call for expressions of interest.

5. What to do if some requests from stakeholders are deemed scientifically unfounded? (p. 12–13, 43–44)

   The agency remains responsible for the scientific integrity of the protocols and can refuse certain proposals, but must justify these refusals and keep a record of them. The guide emphasises the need to use clear scientific reasoning, to acknowledge points of disagreement, and to document them in the reports.

6. How to organise a public restitution meeting without exacerbating tensions? (p. 16–17, 45–46, 53–56)

   The guide recommends thorough preparation (clear objectives, scope, speaking rules, accessible messages, time management) and relies on sheet 1 to detail the facilitation of a public meeting in a sometimes emotional context. It also advises integrating a significant time for exchanges and specifying how the collected remarks will be taken into account.

7. How to evaluate a participatory device once the study is completed? (p. 25, 47, 59)

   Phase 3 explicitly provides for evaluation: analysis of the implementation (adherence to sequencing, representativeness of participants, quality of exchanges) and its effects (on the protocol, on the reception of results, on relationships with stakeholders). The guide suggests capitalising on this feedback to adjust future approaches and highlights the evolving nature of the document.

6. Rewriting in Easy-to-Read Language 

Title

Guidelines for citizen participation at Public Health France.

Context and issues – in Easy-to-Read Language

• Public Health France wants to communicate better with citizens.

• The agency conducts studies on the health of individuals and the environment.

• Sometimes, residents do not understand these studies.

• Sometimes, they do not trust the results.

• This guide explains how to listen to residents and their associations.

• It also explains how to decide with them in certain cases.

Operational contributions – in easy-to-read format

• The guide shows several ways to involve people.

• Providing information, asking questions, discussing together or building a project with the residents.

• It explains when to choose each way of doing.

• It gives simple steps: prepare, facilitate, and explain the results.

• It offers practical sheets for organising meetings.

• It helps teams work better with citizens.

Key points – in easy-to-read format

• Point 1: Participation helps to build trust between residents and professionals.

• Point 2: There are several levels of participation, from simple messaging to shared decision-making.

• Point 3: A criteria grid helps to choose the right level of participation.

• Point 4: Stakeholders are all the people or groups concerned by a project.

• Point 5: Sheets explain how to organise meetings and how to make the results clearer.

7. Cross-analysis – values of health practices

• Literacy: The guide explicitly recommends accessible materials, an approach that is "easy to read and understand" and the use of the framework "Communicate for all" for meetings and documents.

• Empowerment: It aims to develop the capacity of populations to act through information sharing, taking into account experiential knowledge and involving citizens in defining studies and recommendations.

• Participation: It details structured mechanisms of participation (consultations, discussions, co-construction, interface committees, citizen workshops) and their conditions for success.

• Community health: The collective dimension is strong, particularly for local investigations (polluted sites, clusters) where the local community is considered an actor in the process.

• Ethics: The document addresses the risks of manipulation, false participation, possible biases related to the interests at stake, and emphasizes transparency and accountability.

• Human rights: It incorporates the principles of equity and inclusion by stressing the importance of considering vulnerable and discriminated populations, and recognizing citizen knowledge.

• Intersectorality: It lists numerous partners outside of health (environment, work, local authorities, education, technical agencies) and encourages their involvement in the committees.

• Partnership: It describes models of collaboration formalization (committees, consultation charters, dual comitology expertise/management) and their articulation.

• Combating discrimination: It mentions discriminated groups (disability, minorities, travellers, LGBT) and highlights that certain investigations or prevention actions are only possible with their active participation.

8. Evaluation of the reliability of the resource

• Scientific relevance

  • The document relies on a structured bibliography, recognized theoretical references (Arnstein, Rayssac, Mauss, literature on participation and risk) and on feedback from SpF experiences (Lacq, Gardanne, Lubrizol, context studies).

  • It was developed through a multidisciplinary working group, with internal reviews and contributions from the COD, which strengthens the methodological robustness.

  • Its publication date (2025) makes it relevant in light of contemporary practices of health democracy.

• Operational relevance

  • The approaches are clearly broken down into steps, with boxes "in practice", sheets, and concrete examples, facilitating direct use in the field.

  • The guide takes into account real constraints (deadlines, budgets, crises, legal issues) and proposes realistic trade-offs allowing for adaptation to local contexts.